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RA436  R51  Increasing  organic  d 


RECAP 


Columbia  Slntoettfitp 

mtljeCttptfltogark 

College  of  ipfjpstrians;  ano  burgeons; 
3Uorarp 


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in  2010  with  funding  from 

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Increasing  Organic  Disease 

The  New  Public  Health  Problem 


Address  delivered  before 

The  American  Public  Health  Association 

Rochester,  N.  Y., 

September  9,   1915 


By  E.   E.   Ritten house,   President 

LIFE  EXTENSION  INSTITUTE,   Inc. 


25    W.  45TH   STREET 


KS 


INCREASING    ORGANIC    DISEASE 

The  New  Public  Health  Problem. 

Address  of  E.  E.  Rittenhouse,  President  of  the  Life  Extension 
Institute,  Inc.,  at  the  meeting  of  the  American  Public  Health  As- 
sociation,  Rochester,    New  York,   Sept.  9th,   1915. 

What  we  have  to  say  here  upon  this  subject  of  increasing 
organic  disease  will  be  of  service  to  humanity  only  to  the  extent 
to  which  it  encourages  corrective  action. 

With  this  thought  in  mind  let  us  take  the  shortest  and  sim- 
plest road  to  some  of  the  important  facts  and  fundamentals  under- 
lying this  problem.  Let  us  briefly  consider  the  magnitude  and 
significance  of  this  heavy  drain  upon  national  vitality  and  the 
means  of  checking  it. 

MAGNITUDE  OF  THE  LOSS. 

Since  the  great  war  commenced  a  year  ago,  America  has  spent 
80  million  dollars  to  succor  Belgium- — a  glorious  charity.  Dur- 
ing the  same  year  over  400,000  American  adults  died  from  the 
preventable  or  deferable  diseases  of  the  heart,  arteries  and 
kidneys,  including  apoplexy — an  inglorious  sacrifice  to  ignorance 
and  neglect. 

Virtually  all  of  these  annual  deaths  are  premature,  as  we  well 
know,  for  they  can  be  deferred  by  a  proper  observance  of  the 
fundamental  laws  of  individual  hygiene,  and  by  adopting  the 
habit  of  calling  occasionally  upon  medical  science  for  physical 
inspections  for  the  purpose  of  detecting  trouble  in  its  incipiency, 
or  when  it  will  still  respond  to  corrective  measures. 

During  the  past  hundred  years  it  is  estimated  that  the  average 
length  of  life  has  been  increased  fifteen  years  and  it  is  prophesied 
that  another  fifteen  years  will  be  added  during  the  coming 
century.  But  let  us  suppose  that  the  average  age  at  death  of 
those  who  die  every  year  from  organic  disease  could  be  in- 
creased by  but  one  year  in  each  case,  which  is  quite  possible 
with   the  preventive  knowledge   and  experience   which   we  now 


have.  A  saving  would  result  of  400,000  years  of  mature  adult 
life  annually.  The  social  and  economic  value  of  such  a  saving 
is  beyond  human  computation. 

There  are  constantly  at  least  15,000,000  adults  in  America  who 
have  one  or  more  of  these  organic  diseases  in  some  stage  of 
development. 

The  period  of  development  from  the  incipient  to  the  serious 
stage  of  non-acute  diseases  may  range  from  weeks  to  years,  dur- 
ing which  time  they  may  be  detected  by  occasional  physical  ex- 
aminations and  checked  or  cured  if  given  proper  attention.  The 
most  of  these  15,000,000  people  are  drifting  into  these  slowly 
developing  and  deferable  organic  diseases  unknowingly.  The 
State  neither  informs  them  nor  warns  them.  It  is  not  interested 
in  them. 

And  there  is  the  question  of  human  suffering  and  economic 
waste. 

It  is  impossible  for  us  to  visualize  the  millions  who  are 
through  ignorance  or  neglect  drifting  into  organic  disease.  Nor 
can  we  bring  within  our  mental  grasp  a  picture  of  the  extra- 
ordinary total  of  suffering,  sorrow,  poverty,  immorality,  and 
financial  loss  caused  by  this  needless  sickness  and  premature 
death — but  it  is  constantly  going  on,  nevertheless. 

THE  STATE  AND  PHILANTHROPY. 

Americans  are  extremely  generous  in  relieving  distress  from 
acute  causes  such  as  accidents,  floods,  earthquakes,  epidemics  and 
wars.  And,  if  these  400,000  funerals  with  their  millions  of 
mourners  occurred  at  one  time,  and  could  be  visualized  and 
pictured  and  described  in  the  newspapers,  money  to  combat  this 
enemy  would  be  forthcoming  in  abundance. 

But  with  all  our  fabulous  riches,  with  all  our  wealth  of 
scientific  knowledge,  with  all  the  noble  and  charitable  impulses 
of  our  people  which  prompt  them  to  shower  millions  upon  the 
unfortunate  after  trouble  comes,  we  permit  this  enemy  to  ravish 
the  nation  unchecked. 

Go  to  the  philanthropist  or  the  State  and  ask  for  advice  in 
fighting  organic  disease,  and  in  effect  the  answer  will  be : 


"We  can  do  nothing  for  you.  Wait  until  you  are  sick,  then 
we  will  take  care  of  you.  We  are  maintaining  hospitals  for  this 
purpose.  We  will  even  bury  you,  and  send  your  children  to 
an  orphan  asylum.  We  are  very  charitable,  but  will  guard  you 
against  illiteracy,  accidents  and  communicable  disease  only. 
Organic  disease  is  an  act  of  God." 

» 

SOME  FUNDAMENTALS. 

For  the  consideration  of  those  who  are  not  in  accord  with  the 
idea  that  the  public  health  service  should  engage  in  this  educa- 
tional work,  let  us  refer  to  a  few  fundamentals. 

It  is  axiomatic  that  the  primary  purpose  of  organized  society 
is  to  protect  the  lives  of  those  who  compose  it.  Hence,  if  it 
is  a  proper  function  of  the  State  to  protect  a  citizen  from  germ 
diseases,  why  not  from  degenerative  diseases?  If  it  is  right  to 
spend  public  money  to  guard  against  disease  that  may  spread  and 
injure  the  health  of  the  community,  why  is  it  not  right  to  guard 
against  disease  that  is  reducing  the  vitality  of  the  nation? 

The  State  now  denies  the  citizen  the  privilege  of  killing  his 
neighbor  through  ignorance  or  neglect  of  health  precautions,  but 
concedes  him  the  privilege  of  killing  himself  by  the  very  same 
method.  In  other  words,  the  State  goes  to  a  great  deal  of  ex- 
pense to  save  a  man  from  one  disease  to  let  him  die  prematurely 
from  another  without  the  slightest  help  or  warning. 

Is  a  life  saved  from  tuberculosis  or  typhoid  fever  of  any  more 
value  to  the  State  and  to  the  family  than  a  life  saved  from 
Bright's  disease?  Is  it  possible  that  it  is  right  for  the  State 
to  teach  a  citizen  how  to  keep  his  premises  in  a  hygienic  con- 
dition, and  wrong  for  it  to  teach  him  how  to  keep  his  body  and 
its  organs  in  a  healthful  condition? 

There  is  little  to  be  gained  by  extending  the  extreme  span 
of  life,  but  it  is  of  vital  importance  to  our  country  and  to 
posterity  that  we  at  least  check  the  shortening  of  the  active, 
productive  period  of  life. 

Must  we  back  away  from  this  great  problem  of  life-saving 
and  of  race  protection  because  it  is  difficult,  and  continue  to  drift 
along  the  line  of  least  resistance? 


That  is  not  the  American  way.  This  new  burden  has  been 
placed  upon  us  by  the  development  of  modern  civilization  and 

we  must  not  shrink  from  it. 

If  the  human  wastage  from  this  enemy  were  stationary  or 
even  declining,  it  would  still  be  the  imperative  duty  of  American 
lawmakers,  educators,  doctors,  health  officials  and  the  press  to 
make  our  people  see  this  picture  and  to  apply  relief.  How  much 
greater  then  is  the  need  for  action  when  we  consider  the  extra- 
ordinary increase  which  has  occurred  in  the  death  rate  from  these 
organic  diseases? 


THE  MENACE  OF  THE  INCREASE. 

The  increasing  waste  of  American  vitality  and  life  from  de- 
generative diseases  among  wage  earners  and  other  classes  is 
rapidly  reaching  the  magnitude  of  a  national  menace. 

Certain  members  of  the  medical  profession  have  for  years 
believed  that  these  diseases  were  increasing.  But  whether  or 
not  they  were  increasing  out  of  proportion  to  the  gain  in  popula- 
tion could  only  be  determined  by  a  thorough,  tedious  and  some- 
what expensive  search  and  study  and  comparison  of  mortality 
records.  Few  have  had  the  time  or  the  inclination  to  undertake 
this  task.  It  was  done,  however,  and  the  result  can  be  summed 
up  in  the  statement  that  wherever  comparisons  can  be  had  to 
cover  a  period  of  ten  years  or  more  the  records  show  a  marked 
increase  in  the  mortality  from  the  organic  diseases,  and,  as  is  well 
known,  a  decrease  in  the  mortality  from  the  communicable 
diseases. 

Time  forbids  any  extended  reference  to  statistics  or  a  discus- 
sion of  their  reliability  or  the  methods  of  arriving  at  the  ratios. 
\\  e  may,  however,  consider  some  comparisons  in  tabloid  form 
which  have  been  worked  out  from  the  most  reliable  mortality 
data  available.  These  are  presented,  not  to  fix  in  the  mind  any 
arbitrary  ratio  as  being  mathematically  certain,  because  such 
exactness  is  impossible  in  mortality  statistics,  but  to  indicate  the 
trend,  and  to  show  how  completely  the  records  support  the 
statement  that  an  extraordinary  increase  has  occurred  in  the 
mortality  resulting  from  the  giving  out  of  the  organs. 


By  combining  the  mortality  from  the  degenerative  diseases, 
disturbances  of  the  ratios  by  improvement  in  diagnosis  or  clas- 
sification are  obviated  for  such  change  would  not  be  apt  to  take 
them  out  of  this  group.  Any  advance  in  completeness  or  accuracy 
would  be  naturally  too  slight  in  the  short  period  of  ten  years 
to  account  for  the  extraordinary  increase  indicated  by  the  returns. 

The  U.  S.  Census  records  show  that  during  a  period  of  ten 
years  in  a  group  of  occupied  males  numbering  over  4,000,000,  the 
increase  in  the  death  rate  from  the  degenerative  diseases  was 
52%   divided  as   follows : 

Increase 

Laboring  and  servant  class 37% 

Manufacturing  &  Mechanical   Industries 54% 

Agricultural,  transportation  &  other  outdoor  workers.  . .  .66% 

During  the  last  census  interval,  1900-1910,  the  death  rate 
among  the  general  population  from  organic  heart  and  circulatory, 
kidneys  and  apoplexy  increased  in  eight  registration  states  and 
cities  as  follows : 

Increase  Increase 

Maine 28%          Chicago 45% 

Massachusetts    20%         Cleveland    37% 

Connecticut   23%          Milwaukee    30% 

Xew  Hampshire    30%         Philadelphia 20% 

New  York 19%         Cincinnati 43% 

Xew  Jersey    17%  Xew  Orleans   24% 

Michigan 38%         Pittsburgh   53% 

Vermont  35%         St.  Louis 30% 

These  increases  range  all  the  way  from  17%  to  38%  in  the 
states  and  from  20%  to  53%  in  the  cities  in  the  short  period  of 
ten  years.  They  are  confined  to  no  particular  section,  race  or 
condition. 

In  twenty  years,  1890-1910,  it  increased  in  the  registration 
area  41%,  divided  as  follows: 

Increase 

Heart  and  circulatory 46% 

Kidneys  and  urinary 50% 

Apoplexy  and  nervous  system 32% 

The  increase  in  thirty  years,  1880-1910,  in  the  death  rate 
from  the  heart,  kidneys  and  apoplexy  in  sixteen  American  cities, 


in    New   Jersey    and    Massachusetts    (with    paralysis,    liver    and 
circulatory  diseases  added  in  the  latter)   was  as  follows: 

Increase 

Sixteen   cities    94 % 

New  Jersey   108% 

Massachusetts 86% 

It  is  a  significant  fact  that  the  mortality  from  these  diseases 
in  England  and  Wales,  Sweden  and  other  hygienically  advanced 
nations  has  been  either  stationary  or  declined  during  these  three 
decades. 

OTHER  EVIDENCE. 

In  the  general  population  in  New  York  City,  Dr.  Guilfoy's 
comparison  of  a  thirty-year  period  shows  a  marked  decline  in 
the  expectancy  of  life  commencing  with  the  group  age  40-o0. 

Another  interesting  bit  of  evidence  is  found  in  the  record  of 
rejections  of  applicants  for  life  insurance  by  a  large  American 
company.  Out  of  20,336  rejections,  8,782  or  43%  were  declined 
for  physical  impairments  indicating  the  presence  or  the  coming 
of  these  same  degenerative  diseases.  This  is  especially  significant 
in  view  of  the  fact  that  fully  90%  of  these  8,782  people  were 
unaware  of  their  condition  and  under  the  impression  that  they 
were  physically  sound. 

The  careful,  and  I  might  say,  searching  physical  examination 
of  a  large  number  of  individuals  during  the  past  year  by  the 
Life  Extension  Institute  fully  sustains  the  verdict  of  the  general 
mortality,  records  as  to  degenerative  tendencies.  Our  investiga- 
tions have  given  new  emphasis  to  the  fact  that  the  foundations 
of  degenerative  diseases  are  laid  by  a  vast  number  of  people  in 
the  early  years  of  their  lives,  and  that  these  conditions  are  dis- 
coverable long  before  the  individual  knows  of  their  existence. 

As  related  to  this  subject  of  physical  degeneration,  we  might 
discuss  among  other  signs  the  declining  birth  rate,  the  increase 
in  insanity  and  mental  defectives,  the  increasing  consumption  of 
alcohol  and  habit-forming  drugs,  the  diseases  of  vice  and  the 
extraordinary  high  suicide  and  homicide  rate  in  our  country, 
but  all  this  is  another  story. 

TO  SUM  UP. 

To  sum  up,  the  best  available  evidence  shows  that  American 
life   waste   from  the  degenerative  diseases   is  excessive;  that  it 


is  increasing  rapidly,  both  in  city  and  in  rural  population,  and 
among  the  native  and  foreign  born  elements ;  that  it  is  increasing 
in  the  younger  age  groups,  but  in  greater  ratio  in  middle  life 
and  old  age;  that  this  increased  mortality  has  caused  an  increase 
in  the  general  death  rate  commencing  with  age  group  40-50,  and 
that  these  increases  do  not  occur  in  kindred  nations  in  Europe. 
In,  short,  American  vitality  appears  to  be  declining.  In  view  of 
this  evidence  may  we  not  well  consider  these  questions  : 

Warships,  guns,  forts  and  munitions  for  national  defense 
are  now  subjects  of  serious  public  concern,  and  properly  so.  But 
is  it  not  time  to  give  thought  to  the  physical  efficiency  of  the  men 
who  are  to  handle  these  defensive  weapons  now  and  in  the  future? 

How  much  longer  may  we  hope  successfully  to  meet  the 
struggles  of  peace  and  war  with  the  proportion  of  inactive,  flabby- 
muscled,  low-powered  Americans  constantly  increasing? 

How  long  can  the  nation  endure  with  the  physical  fitness  of 
its  producers  and  defenders  steadily  declining? 

This  adverse  trend  is  not  only  very  marked  but  the  death 
rate  from  organic  disease  is  very  high.  The  life  waste  from 
this  cause  is  excessive. 

THE  CAUSE. 

However  opinions  may  differ  as  to  the  cause  or  causes  of  these 
conditions,  we  now  know  that  we  cannot  brush  this  problem 
aside  by  assuming  that  the  statistics  are  valueless,  or  that  the 
saving  of  life  from  infancy  to  the  early  adult  period  from  germ 
diseases  has  given  us  an  increased  number  of  weakened  lives 
which  become  easy  victims  of  the  chronic  diseases  in  middle 
life  and  old  age.  Undoubtedly,  this  influence  will  affect  the 
death  rate  in  the  older  ages  in  the  course  of  time,  but  its  present 
effect  must  be  very  slight  for  the  heavy  reduction  in  mortality  in 
early  life  has  occurred  almost  wholly  since  we  learned  of  germs 
and  how  to  fight  them,  which  is  within  the  past  three  decades. 
Therefore,  very  few  of  these  people  are  old  enough  to  pass  into 
the  age  group  40-50  and  beyond.  Again,  it  should  be  remembered 
that,  while  the  same  reduction  in  mortality  from  the  germ 
diseases  has  occurred  in  the  European  countries,  no  correspond- 
ing increase  in  the  degenerative  diseases  or  in  the  general  death 
rate  in  middle  life  or  old  age  has  occurred  there. 


It  is  possible  that  some  specific  predominating  cause  will  be 
discovered — perhaps  among  our  numerous  microscopic  enemies 
— for  the  downward  tendency  of  the  American  vitality  curve. 

The  most  common  and  plausible  reason  offered  for  this  trend 
is  found,  however,  in  the  statement  that  the  changes  in  living 
conditions  during  the  past  two  generations  have  been  so  rapid 
and  so  extraordinary  that  we  have  not  yet  had  time  to  adjust 
our  lives  to  them.  We  know  that  these  changes  have  been  much 
more  radical  and  abrupt  here  than  in  Europe. 

It  is  a  matter  of  common  knowledge  that  the  high  nervous 
tension  under  which  Americans  work  and  live  is  virtually  un- 
known in  other  countries.  There  is  also  significance  in  the  fact 
that  during  the  past  fifty  years  the  proportion  of  our  population 
which  has  changed  from  an  outdoor  to  an  indoor  life,  or  from 
a  physically  active  to  a  physically  inactive  life,  has  enormously 
increased.  This  has  been  caused  by  the  marvelous  gain  in  our 
wealth,  in  time-saving  and  labor-saving  devices  and  in  cheap 
transportation.  With  all  this  has  also  come  a  change  in  the 
nature  and  richness  of  our  food. 

There  are  millions  of  Americans  who  are  living  physically 
unbalanced  lives  as  a  result  of  these  changes,  to  whose  aid  pre- 
ventive medicine  must  come. 

But  aside  from  the  cause  of  the  increase  in  this  life  waste,  the 
vital  fact  before  us  is  that  we  now  actually  know  of  the  habits 
of  life  which  place  excessive  strain  upon  the  heart,  arteries  and 
kidneys  and  cause  them  to  wear  out  too  soon. 

STIMULATING  INTEREST. 

And  knowing  this,  is  it  not  our  imperative  duty  to  bring  this 
knowledge  to  the  individual  and  to  use  our  utmost  endeavors 
to  induce  him  to  change  these  habits  which  are  reducing  physical 
efficiency  and  shortening  the  active,  useful  years  of  life?  This 
being  a  national  problem,  the  duty  of  leading  in  this  great 
educational  movement  rests  with  the  men  of  the  public  health 
service — local,  state  and  national — who  have  been  entrusted  with 
national  health  defense. 

The  health  service  has  already  had  marked  success  in  spread- 
ing knowledge  of  individual  and  household  hygiene  as  related 
to  communicable  disease.     Think  of  the  impetus  that  would  be 


given  this  broader  movement  to  include  organic  disease,  if  every 
health  official  in  the  country  were  doing  his  part  to  stimulate  and 
educate  the  public  upon  this  subject.  We  know  that  this  can  be 
done  if  we  develop  a  little  crusading  spirit,  and  set  about  it. 

The  reason  I  feel  so  positive  that  this  can  be  done  is  because 
of  my  own  experience  in  helping  to  arouse  interest  in  the  in- 
crease of  organic  disease.  A  brief  account  of  this  experience 
may  be  of  value  for  the  encouragement  of  recruits  to  this  health 
and  life  saving  cause,  and  it  is  therefore  given  with  the  hope 
that  the  personal  reference  may  be  pardoned. 

This  apparent  increase  in  the  degenerative  diseases  first  came 
to  my  notice  several  years  ago  through  my  present  colleague, 
Dr.  Eugene  L.  Fisk.  He  was  then  medical  director  of  the 
life  insurance  company  of  which  I  was  President,  and  had 
already  become  interested  in  the  subject.  The  importance  of  this 
increasing  menace  to  national  vitality  impressed  me  deeply  and 
I  determined  to  enlist  permanently  in  the  work  of  helping  to 
secure  public  recognition  of  the  seriousness  of  the  problem. 

At  that  time  this  adverse  trend  was  quite  generally  ignored. 
So  far  as  could  be  learned  no  effort  was  being  made  to  impress 
the  professional  world  and  the  public  with  its  significance  and 
the  urgent  need  for  remedial  action. 

We  searched  and  interpreted  the  records.  The  results  were 
given  to  the  public  through  the  press  and  by  other  methods. 
This  work  has  since  been  very  much  broadened.  Gradually  help 
began  to  come.  Slowly  but  surely  professional  writers  and 
leaders  in  the  general  field  of  prophylaxis  began  publicly  to 
discuss  the  subject  in  some  of  its  phases.  And  now,  thanks  to 
this  growing  interest  and  help,  the  importance  of  the  increase 
of  degenerative  diseases  is  in  a  fair  way  to  be  generally  recognized 
as  a  problem  meriting  national  concern. 

In  1909  we  established  in  the  same  company  the  first  health 
bureau  in  a  life  insurance  company  for  the  purpose  of  giving 
free  medical  examinations  and  hygienic  knowledge  to  policy- 
holders, and  with  most  gratifying  results  in  the  mortality  rate 
of  the  group  taking  the  service.  At  the  same  time  the  Metro- 
politan Life  Insurance  Company  engaged  on  a  large  scale  in 
another  phase  of  health  conservation,  and  has  since  included 
free  examinations  to  a  portion  of  its  policyholders. 


For  three  years,  while  I  was  associated  with  one  of  the  large 
life  companies,  the  campaign  was  continued,  and  the  subject 
urged  upon  the  attention  of  a  large  constituency  through  a  com- 
pany publication.  While  this  period  was  too  short  to  justify  the 
claim  that  any  marked  impression  was  made  on  the  mortality 
of  the  group,  it  is  comforting  to  know  that  the  mortality  of  this 
company  has  dropped  materially  during  the  past  two  years.  This 
company  is  also  offering  free  health  examinations  to  a  portion 
of  its  policyholders. 

While  insurance  companies  move  slowly  in  such  matters,  their 
general  concern  in  health  conservation  has  increased,  and  a 
number  of  them,  perhaps  eight  or  ten,  are  now  giving  free  medical 
examinations  to  certain  groups  of  policyholders,  and  others  are 
occasionally  issuing  educational  literature. 

Out  of  the  growth  of  interest  in  this  general  subject  developed 
the  sentiment  that  found  concrete  expression  in  the  organization 
of  the  Life  Extension  Institute.  This  was  done  not  by  the 
insurance  companies  as  many  suppose,  but  by  Mr.  Harold  A. 
Ley  and  his  friends,  with  the  enthusiastic  and  effective  support 
of  Professor  Irving  Fisher  who  was  a  prominent  and  an  early 
pioneer  in  this  movement  and  also  of  former  President  W.  H. 
Taft. 

It  is  important  that  the  growth  of  this  campaign  to  stimulate 
interest  should  be  known,  that  those  who  wish  to  help  may  not 
be  deterred  by  the  scepticism  of  the  same  type  of  friends  who 
assured  us  several  years  ago  that  such  efforts  would  be  fruitless. 

HELP  FROM  THE  HEALTH  SERVICE. 

Now,  if  this  much  can  be  accomplished  by  the  comparatively 
small  group  of  people  engaged  in  this  educational  campaign  dur- 
ing the  past  few  years,  what  may  we  not  hope  to  accomplish 
during  the  coming  five  years  if  the  public  health  service — local, 
state  and  national — throughout  the  country  joins  in  the  good 
work? 

We  know  that  a  few  health  officers  are  alreadv  moving  in 
this  direction.  The  New  York  State  Health  Department  has 
taken  up  this  educational  problem  and  a  part  of  the  state  travel- 
ing exhibit  is  devoted  to  degenerative  diseases.  The  New  York 
City  Department  has  examined  a  number  of  city  employes  and 

10 


is  urging  the  public  to  adopt  the  habit  of  health  examinations. 
It  has  also  taken  up  organic  disease.  It  would  repay  anyone 
to  read  the  papers  of  Doctors  Shipley  and  Emerson  of  that  de- 
partment upon  this  subject. 

Recently  the  United  States  Public  Health  Service  issued  a 
valuable  educational  pamphlet  by  Dr.  F.  E.  Smith  on  exercise 
anfl  health  in  which  attention  is  called  to  the  lowered  expectancy 
of  life  above  age  40  and  to  the  need  of  combating  the  increasing 

diseases  of  degeneration. 

There  are  doubtless  other  departments  working  in  this  field 
of  which  I  am  not  informed.  I  know  that  Dr.  Rankin  of  North 
Carolina,  Dr.  Woodward  of  Washington,  D.  C,  Dr.  Hurty  of 
Indiana,  and  a  number  of  other  health  officers  are  deeply  in- 
terested. I  regret  I  cannot  recall  the  names  of  each  of  them. 
The  records  of  this  Association  also  show  an  increasing  concern 
in  this  problem. 

Nor  must  we  overlook  the  increasing  number  of  medical  men 
and  laymen,  outside  the  health  service,  who  are  now  giving  at- 
tention to  this  subject. 

The  wonderful  achievements  of  the  public  health  service  in  com- 
bating communicable  disease  has  compelled  public  confidence. 
The  average  health  officer  has  more  influence  with  the  public  than 
he  imagines,  if  he  will  but  exercise  it.  We  have  had  an  illus- 
tration of  this  at  this  convention : 

The  Governor  of  New  York  said  here  two  nights  since :  "I  have 
good  hope,  now  that  the  problem  is  clearly  recognized,  that  your 
efforts  to  induce  the  public  to  observe  the  rules  of  personal 
hygiene  and  to  undergo  a  periodic  medical  examination  for  the 
detection  of  these  diseases  at  a  curable  stage  will  bear  fruit  in 
the  near  future.  I  shall  personally  make  every  effort 
to  follow  the  rules  of  moderation  in  all  things."  And  Secre- 
tary Redfield  of  the  President's  Cabinet  said  last  night:  "I 
take  it  that  preventive  medicine  has  it  within  its  power  to 
reduce  our  annual  death  roll  by  half  a  million,  and  that  if 
it  had  the  funds  and  the  authority  it  could  within  a  few  brief 
years  at  most  produce  this  wonderful  result.  If  I  am  correctly 
informed  we  know  what  is  to  be  done  and  how  to  do  it  and  we 
have  the  organization  through  which  the  saving  of  pain  and  of 

11 


loss  can  be  effected.    We  lack  as  yet  the  vision  out  of  which  must 
come  the  impulse  to  do." 

It  is  through  public  health  officials  that  these  prominent  leaders 
have  become  interested  in  public  health. 

Any  health  official  or  physician  who  does  not  now  know  the 
modern  rules  of  individual  hygiene  can  inform  himself  with  a 
reasonable  amount  of  reading.  He  can  soon  learn  of  the  habits 
of  eating,  drinking,  working,  resting,  playing,  that  injure  the 
organs  and  of  those  that  tend  to  conserve  them.  If  he  will  keep 
these  rules  before  the  public,  as  much  as  possible,  he  cannot  help 
but  make  an  impression  upon  the  minds  and  lives  of  many  people. 
THINGS  TO  DO. 

For  instance,  by  persistently  urging  the  formation  of  "hiking" 
or  walking  clubs  to  enable  people  in  sedentary  occupations  to 
get  natural  outdoor  exercise  at  least  once  a  week,  "hiking"  clubs 
will  soon  become  the  vogue  in  that  community — as  I  understand 
they  now  are  in  some  towns.  Why  not  officially  encourage  this 
outdoor  habit? 

Every  health  officer  knows  there  should  be  a  course  in  personal 
hygiene  taught  in  both  the  elementary  and  the  higher  grades  in 
public  schools.    Why  not  advocate  this? 

Every  health  officer  knows  that  the  public  should  study  and 
observe  the  common  laws  of  individual  hygiene.  He  also  knows 
that  every  citizen  should  go  to  his  doctor  periodically  for  health 
examination  as  a  simple,  sane  preventive  measure.  Why  then 
should  every  health  officer  not  make  it  his  permanent  policy  to 
urge  the  people  by  bulletins,  press  articles,  lectures,  etc.,  to  adopt 
these  very  sensible  health  and  life-saving  habits?  Why  not  try 
it?    Are  not  these  endangered  lives  worth  the  effort? 

Aid  can  be  secured  in  this  new  educational  work  by  interesting 
private  physicians,  medical  societies,  civic  bodies,  social  organiza- 
tions, religious  organizations,  colleges,  public  school  officials,  in- 
surance agents'  associations,  fraternal  insurance  orders,  charitable 
and  relief  societies,  moving  picture  theatres,  public  service  cor- 
porations, other  employers  of  men  and  women  and  newspapers 
and  magazines. 

Some  of  these  agencies  will  help  distribute  hygienic  literature, 
some  of  them  will  assist  in  securing  audiences  and  even  lecturers, 
and  to  promote  exhibits,  health  day  exercises,  etc.     In  fact,  if 

12 


the  health  officer  will  but  lead,  if  he  will  lay  out  an  educational 
campaign  for  the  year,  and  earnestly  and  patiently  push  it,  he 
will  open  up  a  splendid  new  field  of  usefulness  and  with  little 
cost  to  the  public. 

In  the  work  of  the  Institute,  we  are  constantly  sending  many 
people  to  their  doctors,  their  dentists,  their  oculists.  Therefore, 
W0  know  from  experience,  as  well  as  from  the  history  of  recent 
years,  that  the  people  will  heed  hygienic  advice.  They  will  learn, 
but  they  will  not  educate  themselves ;  they  must  be  taught.  And 
they  must  depend  largely  upon  the  medical  profession  and  the 
public  health  service  to  lead  them  from  the  ignorance  and  folly 
which  is  now  costing  so  many  precious  lives  and  threatening  the 
vitality  of  the  nation. 

CONCLUSION. 

To  quote  a  few  lines  recently  from  the  pen  of  Professor  Irving 
Fisher:  "A  great  health  movement  is  sweeping  over  the 
entire  world.  Hygiene  has  repudiated  the  outworn  doctrine  that 
mortality  is  fatality  and  must  exact  year  after  year  a  fixed  and 
inevitable  sacrifice.  It  aims  instead  to  set  free  human  life  by 
applying  modern  science.  A  science  which  has  revolutionized 
every  other  field  of  human  endeavor  is  at  last  revolutionizing 
the  field  of  health  conservation     *     *     *. 

"Thoroughly  carried  out,  individual  hygiene  implies  symmetry 
and  beauty;  it  enormously  increases  our  capacity  to  work,  to  be 
happy,  and  to  be  useful ;  it  develops,  not  only  the  body,  but  the 
mind  and  the  heart ;  it  ennobles  the  man  as  a  whole." 

In  conclusion,  let  us  paraphrase  the  famous  civic  oath  of  the 
Athenian  youth,  and  make  it  refer  to  health,  instead  of  the  city, 
and  let  us  hope  that  the  time  will  come  when  this  sentiment  is 
displayed  and  observed  in  every  school  and  home  in  the  land: 

We  will  fight  for  the  ideals  and  sacred  blessings 
of  health,  both  alone  and  with  many;  we  will  re- 
vere and  obey  the  hygienic  laws  and  do  our  best  to 
incite  a  like  respect  and  reverence  in  those  above  us 
who  are  prone  to  annul  or  to  set  them  at  naught ; 
we  will  strive  unceasingly  to  quicken  the  public 
sense  of  hygienic  duty.  Thus,  in  all  these  ways,  we 
will  transmit  this  human  body  not  less,  but  greater, 
better  and  more  beautiful  than  it  was  transmitted 
to  us. 

13 


THE  INSTITUTE. 

This    Institute  is  dedicated  to  the  work 
of  human  salvage.      It  is  counseled  by  a 
Hygiene  Reference    Board  of    100  emi- 
nent   authorities    and    students    in     the 
various  fields  of  health  and  life  conserva- 
tion.      The   Chairman  of  this  board   is 
Prof.  Irving  Fisher  of  Yale;  Hon.   Wm. 
H.    Taft  is    Chairman    of   the   board    of 
Directors,   Gen.  Wm.  C.  Gorgas  is  Con- 
sultant in  Sanitation.     It  was  established 
by   a    group  of  scientists,    publicists  and 
business  men,  who  desired  to  provide  a 
self-supporting  central  institute  of  national 
scope,   devoted  to  the  science  of  disease 
prevention — a  responsible  and  authorita- 
tive source  from  which  the  public  might 
draw   knowledge  and  inspiration  in  the 
great  war  of  civilization  against  needless 
sickness  and  premature  death     Literature 
descriptive  of  its  organization  and  purpose 
supplied  on  application. 


E.  E.  Rittenhouse,  President 

Life  Extension  Institute,  Inc. 

25  West  45th  Street, 
New  York  City. 


NEW    YOR  K      NY. 


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